National Center for HIV/AIDS, Viral Hepatitis, STD, 

and TB Prevention Division of STD Prevention

1

CDC’s Recommendations for Providing 

Quality STD Clinical Services, 2020

January 28, 2020

12 Noon- 1 pm Eastern Standard Time

Program Development and Quality Improvement Branch 

Division of STD Prevention

Centers for Disease Control and Prevention
Welcome to the Webinar on CDC’s Recommendations 

for Providing Quality STD Clinical Services, 2020

An Introduction to CDC’s Recommendations for 

Providing Quality STD Clinical Services, 2020

Gail Bolan, MD

Director, Division of STD Prevention

2
Webinar Overview 

 Intended audience:

This webinar is for providers of clinical care services for people with 

or at risk for STDs in public and private health care settings (e.g., STD 

specialty or sexual health clinics, primary care settings, HIV care, 

family planning care, public health department clinics, community 

health centers, health maintenance organizations). 

 This webinar will:

– Emphasize the importance of STD clinical services in STD 

prevention

– Provide an overview of the Recommendations for Providing 

Quality STD Clinical Services, 2020

– Include:

– A Q&A session (please submit questions in chat box-indicate slide 

number and topic)

– Additional resources

 Slides will be posted and webinar will be recorded

3
Participant Poll #1

 If you work in a clinic, what is your primary role?

1. Medical Director

2. Clinician

3. Clinic Manager

4. Health Educator

5. DIS

6. Patient Navigator

7. Other

4
Participant Poll #2

 If you work in a non-clinic setting, what is your primary role?

1. STD Program Manager

2.HIV Program Manager

3.DIS

4.Health Educator

5.Non-Profit Agency

6.Government Agency

7.Other

5
Participant Poll #3

 Which HHS region is your healthcare facility/public health office located?

Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and 

Vermont

Region 2: New Jersey, New York, Puerto Rico, and the Virgin Islands

Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West 

Virginia

Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South 

Carolina, and Tennessee

Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin

Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

Region 7: Iowa, Kansas, Missouri, and Nebraska

Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the 

Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall 

Islands, and Republic of Palau

Region 10: Alaska, Idaho, Oregon, and Washington

6
STD Landscape
STIs are on the Rise in the United States 

8
Drivers and Determinants for the Rising Incidence of Syphilis in MenWho-Have-Sex-With-Men (MSM)

Primary and Secondary Syphilis Rates (per 100,000 population) United States 1963 - 2017

0

100

200

300

400

500

1963 1968 1973 1978 1983 1988 1993 1998 2003 2008 2013 2018p

Rate per 100,000 population

MSM

MSW

Female 1981: AIDS

1996: 

HAART

2001: Phone Dating Apps 

(MSM)

2012: PrEP

Mid-2000s: Erosion 

PH Infrastructure

1969: Stonewall Riots

Adapted by Bernstein from Peterman TA et al., Syphilis in the United States: on the rise?, Expert Rev Anti Infect Ther. 2015 

9
Congenital Syphilis Cases and Rates of Primary & 

Secondary Syphilis Among Women, 2009-2018

In 2018, 5 states represented 70% of all congenital syphilis cases in the U.S.

0

2

4

6

8

0

500

1000

1500

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

P&S syphilis rate 

(per 100,000 females aged 15

–44 years)

# of CS cases

Year

CS cases

1306

334

935

10
Drivers and Determinants for the Rising Incidence of 

Syphilis in Women

 Risk factors for syphilis among women include:

– Multiple sex partners

– Substance use disorders

– Unstable housing

– History of incarceration

– History of exchanging sex for drugs/money/housing 

– Having a sex partner with multiple sex partners or a history 

of incarceration

 Among pregnant women with syphilis, late or no prenatal care 

is significantly associated with delivering an infant with 

congenital syphilis 

CDC Public Health Grand Rounds, Bowen V, Surveillance for Emerging Threats to Pregnant Women and Infants: Data for Action, 201 

11
Drivers and Determinants for the Rising Incidence of 

Syphilis in Women

Substance Use Among Syphilis Cases

Heroin Use Meth Use

Injection Drug Use Crack Use

Kidd SE et al., MMWR 2019 

12
Missed Opportunities to Prevent Congenital Syphilis (CS) 

Mothers of Reported Congenital Syphilis Cases (n=918), U.S., 2017

Missed Prevention Opportunities N %

1. Prenatal Care: Received late or no prenatal care and not screened in time 309 34% 

2. Screening: Received prenatal care, but not screened in time to treat

adequately for CS 61 7% 

3. Treatment: Positive initial screening test, but inadequately treated for CS 256 28%

4. Re-screening: Negative initial screening test, but later infected and

detected at delivery 126 14%

Other 27 3%

Missing Data: Unknown/inadequate testing or treatment data 139 15%

Total 918 100%

Late prenatal care is < 30 days prior to delivery; timely screening is ≥ 30 days prior to delivery

CDC, 2017 National Case Report Data, 2018 

13
National Strategies Informing STD Priorities

IOM Report on 

Women’s Preventive 

Services 2011

Healthy People 

2020 & 2030

National Prevention 

Strategy 2011 

National Strategy on 

Combating Antibiotic 

Resistant Bacteria 2014 

National HIV/AIDS 

Strategy 2015 

Ending the HIV Epidemic 

Initiative 2019 

NAPA Report

Part 1 - 12/13/2018

Part 2 - 11/19/2019

STI Federal Action 

Plan - pending 

release 2020

1997 Hidden 

Epidemic Update, 

NASEM - pending 

release 2021

14
DSTDP Vision

A society where people are empowered to achieve sexual health and protect 

themselves and others from STD

DSTDP Mission 

To maximize the impact of STD prevention through integrated program, 

science, and policy to achieve healthy populations

Goals

• Eliminate congenital syphilis

• Prevent primary and secondary 

syphilis

• Prevent antimicrobial resistant 

gonorrhea

• Prevent STD related PID, ectopic 

pregnancy, and infertility

Strategies 

• Enhance STD surveillance

• Promote cost-effective STD 

interventions (e.g. outbreak 

investigations, testing and 

treatment, partner services, 

linkage to care)

• Increase uptake of CDC screening 

and treatment recommendations

• Strengthen the evidence for STD 

prevention and control

15
Role of STD Clinical Services 

in the United States

 Primary care and related clinical settings 

are critical to prevent and control STDs in 

the US

 In 2018, between 71% -78% of chlamydia, 

gonorrhea, P&S syphilis cases are diagnosed in 

primary care or related settings (not in publicly 

funded STD clinics)

 Publicly funded STD Specialty Clinic 

settings also play an important role 

in addressing STDs by offering same–

day, culturally sensitive, safety net, 

confidential STD evaluation and 

treatment services for patients and 

sexual contacts and serving as a 

community resource for both 

patients and providers

16
Need for national guidance

quality STD care by providers 

offering basic or specialized 

STD care

Complement to the CDC STD 

Treatment Guidelines with 

emphasis on clinical 

operations

Modeled after Quality Family 

Planning Services 

Recommendations

16
Overview of CDC’s Recommendations for 

Providing Quality STD Clinical Services, 2020 

Roxanne Barrow, MD, MPH

Medical Epidemiologist

Division of STD Prevention

18
Recommendations for Providing Quality 

STD Clinical Services (STD QCS) Overview

Key Questions for Development

Scope and Purpose

Levels of Care in

Primary and STD Specialty Care Settings

Development of Recommendations

STD Clinical Services

19
STD QCS Recommendation Development Process

Steering Committee

Basic and Specialized 

Workgroups

Consultation 

Meeting

Federal 

Advisory 

Committee-CHAC

CDC STD Workgroup

20
Key Questions as Starting Point for Recommendations 

What STD-related clinical services should be available 

to persons who have or are at risk for STDs, including 

asymptomatic persons, in primary care settings?

What STD-related clinical services should be available 

to persons who have or are at risk for STDs in 

specialized STD care settings?

Which STD-related conditions should be managed 

through consultation with or referral to a specialist?

21
Scope and Purpose 

• Optimal services for 

providing quality STD 

care based on previously 

published guidelines

• Complement to STD 

Treatment Guidelines

Can be used to: 

• Critically assess which 

services are available in 

their facility

• Build, maintain, or enhance 

the delivery of STD services 

as a policy document

NOT intended to: 

• Develop new 

guidance for when or 

how to provide the 

services

• Mandate or regulate 

services 

NOT anticipated that:

• Health care settings will 

provide every service

• Capture every service 

available in clinical settings

22
Recommendation Format

Should be available

 Strong recommendation

 Implies that all or almost 

all informed providers 

would choose the 

recommended course 

of action

Could be available

 Weaker recommendation

 Indicates that most 

informed providers would 

choose the recommended 

course of action, but 

some would not

23
Services Provided within Levels of Care

Basic STD Care

 Recommended risk 

assessment

 Screening and treatment 

of those identified with 

asymptomatic infection



Specialized STD Care

Diagnosis and treatment 

of patients with common 

symptomatic infection

 Comprehensive, culturally 

sensitive, confidential STD 

clinical services

– Basic STD care 

– Same day diagnostic and 

treatment services

• Syphilis testing

• Gram stain/wet mount

• Gonorrhea cultures

• Benzathine penicillin

• Ceftriaxone

24
Level of STD Care in Clinical Settings*

Basic STD Care in Primary Care Settings

Provided in settings where patients are evaluated for a variety of health conditions

 Adolescent Health

 Corrections

 Family Medicine

 Family Planning

 Federally Qualified Community 

Health Center

 HIV care

 OB/GYN

 Pediatrics

 School Based Health Center

 Primary care

Specialized STD Care in STD Specialty Care Settings

Delivered in settings that focus on providing STD care

 STD Specialty Care Clinic

 Sexual Health Clinic

*level of care can vary by individual setting based on the clinical scope

25
Participant Poll #4

 What level of STD care is provided at your healthcare facility?

• Basic STD Care

• Specialized STD Care

26
Recommendations for Providing 

Quality STD Clinical Services 

 Sexual History and 

Physical Examination

 Prevention

 Partner Services

 Screening

 Evaluation of 

STD-related Conditions

 Laboratory Tests

 Treatments

27
How does the STD QCS complement the STI 

Treatment Guidelines?

28
Sexual History and 

Physical Examination
Sexual History and Physical Examination

Primary Care and STD Specialty Settings

 A physical examination for male and female patients with STD-related symptoms, STD-related concerns or

those at high behavioral risk for incident STDs should be available as a basic and specialized STD care service

 A pelvic examination for female patients should be available as a basic and specialized STD care service

Primary Care Settings

 A sexual history and risk assessment should be

available as a basic STD care service at the following

patient visits:

 Initial comprehensive or annual visit

 Each reproductive health, genital or urologic visit

 A sexual history and risk assessment at each visit

unrelated to reproductive, genital, or urologic

concerns could be available as a basic STD care service

 Anoscopy could be available as a basic STD care service

STD Specialty Care Settings

 A sexual history and risk assessment should be available

as a specialized STD care service at every visit for

patients with STD-related symptoms or concerns

including behavioral and pregnancy intention

 Anoscopy should be available as a specialized STD care

service for patients with rectal signs or symptoms

 Colposcopy should be available as a specialized STD

care service for female patients with abnormal PAP

smears

 A high resolution anoscopy could be available as a 

specialized STD care service for patients with abnormal 

anal Pap smears.

30
Sexual History and Physical Examination

Primary Care and STD Specialty Settings

 A physical examination for male and female patients with STD-related symptoms, STD-related concerns or those

at high behavioral risk for incident STDs should be available as a basic and specialized STD care service

 A pelvic examination for female patients should be available as a basic and specialized STD care service

Primary Care Settings

 A sexual history and risk assessment should be available

as a basic STD care service at the following patient

visits:

 Initial comprehensive or annual visit

 Each reproductive health, genital or urologic visit

 A sexual history and risk assessment at each visit

unrelated to reproductive, genital, or urologic concerns

could be available as a basic STD care service

 Anoscopy could be available as a basic STD care service

STD Specialty Care Settings

 A sexual history and risk assessment should be

available as a specialized STD care service at every visit

for patients with STD-related symptoms or concerns

including behavioral and pregnancy intention

 Anoscopy should be available as a specialized STD care

service for patients with rectal signs or symptoms

 Colposcopy should be available as a specialized STD

care service for female patients with abnormal

PAP smears

 A high resolution anoscopy could be available as a

specialized STD care service for patients with abnormal 

anal Pap smears.

31
Sexual History and Physical Examination

Primary Care and STD Specialty Settings

 A physical examination for male and female patients with STD-related symptoms, STD-related concerns or those

at high behavioral risk for incident STDs should be available as a basic and specialized STD care service

 A pelvic examination for female patients should be available as a basic and specialized STD care service

Primary Care Settings

 A sexual history and risk assessment should be available

as a basic STD care service at the following patient

visits:

 Initial comprehensive or annual visit

 Each reproductive health, genital or urologic visit

 A sexual history and risk assessment at each visit

unrelated to reproductive, genital, or urologic concerns

could be available as a basic STD care service

 Anoscopy could be available as a basic STD care service

STD Specialty Care Settings

 A sexual history and risk assessment should be

available as a specialized STD care service at every visit

for patients with STD-related symptoms or concerns

including behavioral and pregnancy intention

 Anoscopy should be available as a specialized STD care

service for patients with rectal signs or symptoms

 Colposcopy should be available as a specialized STD

care service for female patients with abnormal PAP

smears

 A high resolution anoscopy could be available as a 

specialized STD care service for patients with abnormal 

anal Pap smears.

32
Sexual History and Physical Examination

Primary Care and STD Specialty Settings

 A physical examination for male and female patients with STD-related symptoms, STD-related concerns or those

at high behavioral risk for incident STDs should be available as a basic and specialized STD care service

 A pelvic examination for female patients should be available as a basic and specialized STD care service

Primary Care Settings STD Specialty Care Settings

 A sexual history and risk assessment should be available

as a basic STD care service at the following patient

visits:

 Initial comprehensive or annual visit

 Each reproductive health, genital or urologic visit

 A sexual history and risk assessment at each visit

unrelated to reproductive, genital, or urologic concerns

could be available as a basic STD care service

 Anoscopy could be available as a basic STD care service

 A sexual history and risk assessment should be

available as a specialized STD care service at every visit

for patients with STD-related symptoms or concerns

including behavioral and pregnancy intention

 Anoscopy should be available as a specialized STD care

service for patients with rectal signs or symptoms

 Colposcopy should be available as a specialized STD

care service for female patients with abnormal PAP

smears

 A high resolution anoscopy could be available as a

specialized STD care service for patients with abnormal 

anal Pap smears.

33
Sexual History and Physical Examination

Primary Care and STD Specialty Settings

 A physical examination for male and female patients with STD-related symptoms, STD-related concerns or those

at high behavioral risk for incident STDs should be available as a basic and specialized STD care service

 A pelvic examination for female patients should be available as a basic and specialized STD care service

Primary Care Settings

 A sexual history and risk assessment should be available

as a basic STD care service at the following patient

visits:

 Initial comprehensive or annual visit

 Each reproductive health, genital or urologic visit

 A sexual history and risk assessment at each visit

unrelated to reproductive, genital, or urologic concerns

could be available as a basic STD care service

 Anoscopy could be available as a basic STD care service

STD Specialty Care Settings

 A sexual history and risk assessment should be

available as a specialized STD care service at every visit

for patients with STD-related symptoms or concerns

including behavioral and pregnancy intention

 Anoscopy should be available as a specialized STD care

service for patients with rectal signs or symptoms

 Colposcopy should be available as a specialized STD

care service for female patients with abnormal PAP

smears

 A high resolution anoscopy could be available as a

specialized STD care service for patients with abnormal 

anal Pap smears.

34
Prevention and Partner Services
Prevention

Primary Care and STD Specialty Settings

 The following prevention services should be available as a basic and specialized STD service:

 On-site hepatitis B vaccination

 On-site HPV vaccination

 Brief single STD/HIV prevention counseling (up to 30 minutes)

 HIV pre-exposure prophylaxis (PrEP) and HIV nonoccupational postexposure prophylaxis HIV (nPEP) risk 

assessment, education and referral/linkage 

 On-site emergency contraceptive pills or by prescription

 Brief contraceptive counseling or referral

 Referral/linkage to HIV care, family planning services, and behavioral health services, if indicated

 The following prevention services could be available as a basic and specialized STD service:

 Moderate intensity STD behavioral counseling( ≥30 minutes)

Primary Care Settings

 The following prevention services could be 

available as a basic STD service:

 On-site condom provision

 On-site hepatitis A vaccination

 PrEP and nPEP provision

Specialized STD Care

 The following prevention services should be available as a 

specialized STD service:

 On-site condom provision 

 On-site hepatitis A vaccination

 PrEP and nPEP provision

 The following prevention services could be available as a 

specialized STD service:

 High intensity STD behavioral counseling (≥2 hours)

36
Partner Services

Primary Care and STD Specialty Settings

 The following partner services should be available as a basic and specialized STD service:

 Guidance regarding notification and care of sex partners

 Expedited partner therapy (where legal)

Primary Care Settings

 The following partner services could be 

available as a basic STD service:

 Interactive counseling for 

partner notification

STD Specialty Care Settings

 The following partner services should be 

available as a specialized STD service:

 Interactive counseling for 

partner notification

 Health Department Disease Intervention 

Specialist partner elicitation and follow-up

37
STD Screening and Evaluation
Screening

Primary Care and STD Specialty Settings

 Screening and assessment for the following should be available as a basic and specialized STD care service:

 Gonorrhea

 Chlamydia

 Syphilis

 Hepatitis B

 Hepatitis C

 HIV

 Cervical cancer

Primary Care Settings

 Screening and assessment for the following

could be available as a basic STD care service:

 Trichomoniasis

STD Specialty Care Settings

 Screening and assessment for the following

should be available as a specialized STD

care service:

 Trichomoniasis

 Screening and assessment for the following

could be available as a specialized STD

care service:

 Anal cancer

39
Evaluation of STD-related Conditions

Primary Care and STD Specialty Settings

 Evaluation (history and examination) for the following STD-related conditions 

should be available as a basic and specialized STD service: 

 Genital ulcer disease

 Male urethritis syndrome

 Vaginal discharge syndrome

 Pelvic inflammatory disease

 Genital warts

 Ectoparasitic infections

 Pharyngitis

 Epididymitis

 Systemic or dermatologic conditions compatible with or suggestive of an STD etiology*

 Proctitis

*can include disseminated gonorrhea, neurosyphilis, ocular syphilis, otic syphilis, primary syphilis, condyloma lata, or 

palmar, plantar or more generalized syphilitic rash. 

40
Laboratory Tests
Laboratory Tests – At the time of the patient visit 

Primary Care and STD Specialty Settings

 The following tests and equipment should be available as a basic and specialized STD care service at the time of the 

patient visit:

 Thermometer

 pH paper

Primary Care Settings

 The following services or tests could be available onsite 

as a basic STD service with results available during the 

patient visit:

 Phlebotomy

 Test for trichomoniasis

 Test for bacterial vaginosis

 Test for vulvovaginal candidiasis

 Urine dipstick

 Urinalysis with microscopy

 Test for HIV

STD Specialty Care Settings

 The following tests should be available as a specialized STD 

service with results available during the patient visit:

 Phlebotomy

 Gram, Methylene Blue or Gentian Violet stain for 

urethritis

 On-site qualitative non-treponemal serologic test for 

syphilis

 Test for trichomoniasis

 Test for bacterial vaginosis

 Test for vulvovaginal candidiasis

 Urine dipstick

 Urinalysis with microscopy

 Test for pregnancy 

 The following tests could be available onsite as a specialized 

STD service with results available during the patient visit:

 Dark field microscopy for syphilis

 Test for HIV

42
Laboratory Tests – Clinical Laboratory

Primary Care and STD Specialty Settings

 The following tests should be available through a clinical laboratory as a basic and specialized STD service:

 Urogenital NAAT for gonorrhea and chlamydia

 Extragenital (pharynx, rectum) NAAT for gonorrhea and chlamydia

 Quantitative non-treponemal serologic test for syphilis

 Treponemal serologic test for syphilis

 HSV viral culture or PCR

 HSV type specific serology

 4th generation antigen/antibody HIV test 

 Oncogenic HPV NAATs with Pap smear

 nPEP and PrEP

 Serologic tests for hepatitis A, B, C

 Test for pregnancy 

Primary Care Settings

 The following tests could be available through a clinical 

laboratory as a basic STD service:

 Gram stain or Methylene Blue or Gentian Violet 

stain for urethritis

 Gonorrhea culture

 Gonorrhea antimicrobial susceptibility testing

 NAAT for trichomonas

STD Specialty Care Settings

 The following tests should be available through a 

clinical laboratory as a specialized STD service:

 Gonorrhea culture

 Gonorrhea antimicrobial susceptibility testing

 NAAT for trichomonas

43
Treatments
Treatments for STDs or Related Conditions – Onsite

Primary Care Settings

 Treatments for the following STDs or related 

conditions could be available onsite as a basic 

STD service:

 Gonorrhea

 Chlamydia

 Cervicitis

 Nongonococcal Urethritis

 PID

 Proctitis

 Epididymitis

 Syphilis

 Provider-applied regimens for genital warts

 Emergency contraception

 PrEP and nPEP

 Acute/new HIV diagnosis

STD Specialty Care Settings

 Treatments for the following STDs or related conditions 

should be available onsite as a specialized STD service:

 Gonorrhea

 Chlamydia

 Cervicitis

 Nongonococcal Urethritis

 PID

 Proctitis

 Epididymitis 

 Syphilis 

 Trichomoniasis

 Herpes 

 Provider-applied regimens for genital warts

 Emergency contraception

 nPEP

 EPT gonorrhea and chlamydia

 Treatments for the following STDs or related conditions 

could be available onsite as a specialized STD service:

 Bacterial vaginosis

 Persistent and recurrent nongonococcal

urethritis/cervicitis

 Acute/new HIV diagnosis

 PrEP

45
Treatments for STDs or Related Conditions – Prescription 

Primary Care and STD Specialty Settings

 All recommended treatments for the following STDs or related conditions should be available by 

prescription as a basic and specialized STD service:

 Vulvovaginal candidiasis

 Bacterial Vaginosis

 Urinary Tract Infection (UTI)

 Patient-applied regimens for genital warts

 Ectoparasitic infections

 PrEP

Primary Care Settings

 All recommended treatments for the following STDs 

or related conditions should be available by 

prescription as a basic STD service. 

 Herpes

 Trichomoniasis

 Emergency contraception

 nPEP

 All recommended treatments for the following STDs 

or related conditions could be available by 

prescription as a basic STD service. 

 EPT gonorrhea and chlamydia

STD Specialty Care Settings

 All recommended treatments for the following 

STDs or related conditions should be available by 

prescription as a specialized STD service:

 As outlined above under onsite and 

prescription

46
Consultation with or 

Referral to Specialist
Complex STD or Related Conditions for Specialist-1

Primary Care and STD Specialty Settings

 Complex Gonorrhea 

o Complex antimicrobial-resistant gonorrhea

o Cephalosporin or IgE-mediated penicillin allergy

o Suspected cephalosporin treatment failure

o Gonococcal conjunctivitis in adults

o Disseminated gonococcal infection or gonococcal endocarditis or meningitis

o Gonococcal ophthalmia in infants

 Complex Chlamydia

o Chlamydial ophthalmia in infants

o Pneumonia in infants

 Complex Cervicitis and Epididymitis

o Persistent or recurrent epididymitis

o Persistent or recurrent cervicitis

o Cephalosporin or IgE-mediated penicillin allergy

o Suspicion of testicular torsion

 Complex Pelvic Inflammatory Disease

o Cephalosporin or IgE-mediated penicillin allergy (quinolone resistant gonorrhea or 

antimicrobial susceptibility cannot be assessed)

o PID surgical complications (e.g., tubo-ovarian abscess)

48
Complex STD or Related Conditions for Specialist-2

Primary Care and STD Specialty Settings

 Complex Vaginal Discharge, Trichomoniasis, and Candidiasis

o Persistent vaginal discharge of unclear etiology 

o Persistent or recurrent trichomoniasis

o IgE-mediated allergy to nitroimidazoles

o Recurrent vulvovaginal candidiasis in patients who remain culture-positive despite 

maintenance therapy

o Recurrent non-albicans vulvovaginal candidiasis

 Complex Syphilis 

o Primary, secondary, and latent syphilis in infants and children 

o IgE-mediated penicillin allergy*

o Tertiary syphilis 

o Neurosyphilis

o Ocular or otic syphilis

o Syphilis during pregnancy with sonographic signs of fetal or placental syphilis

 Complex Herpes

o Antiviral-resistant herpes infection 

o Genital herpes contracted late in pregnancy

o Neonatal herpes

*in pregnant women or other cases where alternative agents would not be recommended

49
Complex STD or Related Conditions for Specialist-3

Primary Care and STD Specialty Settings

 Complex Warts 

o Cervical or intra-anal warts

o Atypical anogenital warts with high-grade squamous intraepithelial lesion on biopsy

 Cervical intraepithelial neoplasia or Cervical Cancer

o Women with high- or low-grade squamous intraepithelial lesions on Pap smear

 Complex Ectoparasitic Infections

o Crusted scabies in persons with HIV infection

 Sexual Assault

o HIV nPEP being considered

o STDs in children (if suspect possibility of sexual abuse)

50
Participant Poll #5

 For STD Specialty Care Settings, to what extent does your 

facility/clinic currently provide services outlined in the 

recommendations for your facility type?

• Provides most of the recommended services

• Provides some of the recommended services

• Provides very few of the recommended services

• Provides none of the recommended services

• Not applicable to my work

51
Participant Poll #6

 For Primary Care Settings, to what extent does your facility/clinic 

currently provide services outlined in the recommendations for 

your facility type?

• Provides most of the recommended services

• Provides some of the recommended services

• Provides very few of the recommended services

• Provides none of the recommended services

• Not applicable to my work

52
Next Steps
Next Steps

1

Develop Tools and Resources for Implementation

2

Pilot Tools in STD Specialty Clinics

3 Webinar to Launch User Package 

4 Continuing Education Activities

54
Additional Resources
STD Resources 

CDC: cdc.gov/std/default.htm

2018 Surveillance Report: 

https://www.cdc.gov/std/stats18/d

efault.htm

STD Treatment Guidelines: 

www.cdc.gov/std/tg2015 

/default.htm 

NNPTCs: 

www.nnptc.org www.STDCCN.org 

National Coalition for Sexual 

Health: 

www.ncshguide.org/providers 

www.ncshguide.org
National Network of STD Clinical 

Prevention Training Centers (NNPTC) 

Resource: www.nnptc.org │ www.STDCCN.org

Denver Public 

Health

University of California, 

San Francisco

University of 

Washington

Washington University 

in St. Louis

Johns Hopkins 

University

Massachusetts 

Department of 

Public Health

University of Alabama 

at Birmingham

Columbia University

Offering STD 

treatment resources
58
Questions and Answers
Recommendations for Providing Quality STD Clinical Services

Panel Members for Q & A

Laura Bachmann, MD, MPH, FIDSA

Chief Medical Officer

Division of STD Prevention, CDC

Kimberly Workowski, MD, FACP, FIDSA

Lead Author, CDC STI Treatment Guidelines

Professor of Medicine, Department of 

Infectious Diseases, Emory University

60
Roxanne Barrow, MD, MPH

rbarrow@cdc.gov

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.